Healing in a Blockade Context

Cuban doctors have been deployed all over the world to heal and to strengthen bilateral relations. In 2017, they came to Chicago to address extreme disparity and an urgent community need.

The University of Illinois Chicago-Cuban Ministry of Health collaboration is a first: American doctors invited Cuban medical professionals into American communities to help improve maternal and child health outcomes in underserved Chicago neighborhoods. This collaboration is a milestone in cooperative US-Cuban relations, and in Cuba’s medical diplomacy.

Dr. Armando Arronte Villamarin and two other Cuban health professionals came to Chicago in January of 2017 to visit University of Illinois Hospital & Health Sciences System (UI Health) clinics and discuss the potential of applying a Cuban-style home visit system, where doctors have the chance to observe patients, and their conditions, in their own home. During their next visit to Chicago, the doctors began the at-home interviews to assess the patients and determine their health needs at the individual and, cumulatively, community levels.

“It has been a fantastic experience,” says Dr. Robert Winn, director of the University of Illinois Cancer Center and Associate Vice Chancellor of UI Health’s community-based practice.

Cuban doctors are diplomatic commodities for the Cuban government, both as official representatives and exportable healthcare products. The foreign health missions have put Cuban doctors on the ground in more than 100 countries over the years, as part of everything from long-termd agreements to immediate disaster relief. For some doctors, like Dr. Armando, representing Cuba abroad is their opportunity to “say thank you to the Cuban revolution” and care for people in need wherever they are.

The success of the Cuban medical system, and medical diplomacy as an extension has been an impressive example of the utilization of human capital in the face of resource scarcity. Leveraging what they had available – namely educated men and women with an intense belief in the value of their work and a close connection to the community – Cuban health professionals made up for what they did not have, like the high-tech tools American institutions take for granted.

Since the end of the Cuban revolution in 1959, relations between the United States and communist Cuba in all aspects of diplomacy could be described as strained at best. Specifically within medical diplomacy, the two nations have a mixed record. The American Cuban Medical Professional Parole Program, ended January 2017, allowed “doctors … sent by the Government of Cuba to work or study in third countries … [to] request parole into the United States,” therefore encouraging defection. Nevertheless, Cuban offers of medical aid for American victims of natural disasters, most memorably Hurricane Katrina, have gone unanswered by the White House.

On the other hand, individuals and organizations have found ways to learn from the Cuban system. American students have graduated from the Havana-based Latin American School of Medicine (ELAM), but Dr. Winn says they do not always get the chance to use their Cuban training at home because of the American system’s emphasis on “mov[ing] patients in and mov[ing] patients out.” American organizations have also worked with Cuban doctors abroad, like in the multinational brigades to Honduras in the late 2000s. Additionally, the two nations have worked together in Cuba in the Community Partnerships for Health Equity, which are “communities whose leaders have been inspired to innovate for better health, thanks to their [Medical Education Cooperation with Cuba (MEDICC)]-organized experiences in Cuba.”

To the international community, Cuba has been relatively open to collaboration or at least has maintained an image of being relatively open. The United States and Cuba have mutually acknowledged and supported each other’s medical diplomacy efforts in disaster situations like the 2010 earthquake in Haiti and the Ebola crisis, and new projects are paving the way for a stronger health partnership. The efforts of organizers like UI Health’s Dr. Kathy Tossas-Milligan, director of the Office of Global Cancer Health Equity, and projects like UIC’s pressure for regulatory change.

In October 2016, the US Office of Foreign Assets Control amended the Cuban Assets Control Regulations to authorize joint medical research projects under a general license and “transactions incident to obtaining [FDA] approval … of Cuba-origin pharmaceuticals,” including clinical research at institutes, such as the Roswell Park Cancer Institute. The institute, in New York, has been working with the Cuban Center for Molecular Immunology (CIM) since 2011, and in 2016 received FDA permission for a clinical trial of a CIM-manufactured lung cancer vaccine – as their only American partner and the first in the US to get permission to test a Cuban treatment.

The prospects for further collaboration are exciting. For the doctors, their work is about the patients, not blockade policy.

Since the health professionals knew they were doing nothing wrong, says Dr. Tossas-Milligan, “we [could] be free and open to build bridges.” Despite the rocky relations between the countries, Dr Armando insists that their project “is a matter of people … not policy, not government.” In Dr. Winn’s words: “People are getting together to better serve humanity … and better serve communities.”

While this partnership may have just been another step in the global path of Cuban medical diplomacy, it has been a groundbreaking moment in US-Cuban diplomacy and cooperation.

In the next installment of this series, we will look at the impacts of the program, from the block to the blockade.

The content of this piece and series is based on interviews with medical doctors involved with the UIC-Cuban Ministry of Health program.